Failure of Fresh-Frozen Radial Head Allografts in the Treatment of Essex-Lopresti Injury: A Report of Four Cases

Abstract

E ssex-Lopresti described a traumatic radial head fracture with associated disruption of the interosseous membrane and secondary proximal migration of the radius1. The combined long-term effect of this injury on the radiocapitellar and distal radioulnar joints is both pain and loss of mobility2-5. Reconstructive management of these lesions has been very difficult and has yielded variable, mostly unfavorable results2,6. The accepted basis of management consists of reestablishing the longitudinal relationship of the radius to the ulna. This allows anatomic realignment of the proximal radioulnar joint, the distal radioulnar joint, the proximal and distal ligaments, and the interosseous membrane. This can be accomplished by reestablishing the length of the proximally migrated radius, by shortening the ulna, or by a combination of the two. In 1998 and 1999, four patients with established symptomatic proximal radial translation secondary to prior trauma and radial head excision were treated at our institution with a total of five frozen radial head allografts. Treatment was tailored on the basis of each patient's specific problems. All elbows were approached through a lateral incision extending through the Kocher interval. After the scar around the radial head was released and the proximal aspect of the radius was refreshed, a matching allograft radial head was tailored to fit the radiocapitellar gap. Ulnar shortening osteotomy was carried out in three of the four patients to treat ulnar carpal abutment causing ulnar wrist pain associated with axial instability of the forearm. A midline ulnar incision was used to apply a slotted plate (the Rayhack plate) designed for ulnar shortening (Creative Medical Design, Tampa, Florida). After proper length and alignment were achieved, the allograft was fixed with one 2.7-mm plate in two patients and with two mini-plates in the other two. Transverse end-to-end apposition …